AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS
Company Name:			Kappa Mu Chapter of Kappa Sigma Housing Corporation
			(DBA:  TTU Kappa Sigma Alumni Association)
ID Number:			237068074
Monthly Contribution
I hereby request that the following amount be deducted from my checking account on the first of each
month as a contribution to the Kappa Mu Chapter of Kappa Sigma Housing Corporation.
			$      5.00			$   20.00			$   40.00
			$    10.00			$   25.00			$   50.00
			$    15.00			$   30.00			$ 100.00
Authorization
I hearby authorize the Kappa Mu Chapter Housing Corporation hereafter called CORPORATION, to
initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries
in error to my checking account indicated below and the depository named below, hereinafter called
DEPOSITORY, to debit and/or credit the same to such account.
Depository Name:
City						State:
Bank Transit / ABA NO.
Checking Account No.
This authority is to remain in full force and effect until the CORPORATION has received written
notification fro me of its termination in such time and in such manner as to afford the CORPORATION
a reasonable opportunity to act on it.
Print Name:
Signature
Date
Please print this form, complete each section, attach a voided check, and return to:
			TTU Kappa Sigma Alumni Association
			P. O. Box 52654
			Knoxville, TN 37950